This Certificate contains a Conversion Privilege.

Transcription

1 Jefferson Pilot Financial Insurance Company 8801 Indian Hills Drive, Omaha NE (800) A Stock Company CERTIFIES THAT Group Policy No. GL has been issued to Berklee College of Music (The Group Policyholder) The Issue Date of the Policy is August 1, This certificate supercedes and replaces any previously issued certificate with an effective date of August 1, The insurance is effective only if the Employee is eligible for insurance and becomes and remains insured as provided in the Group Policy. Certificate of Insurance for Class 4 You are entitled to the benefits described in this Certificate if you are eligible for insurance under the provisions of the Policy. This Certificate replaces any other certificates for the benefits described inside. As a Certificate of Insurance, it is not a contract of insurance; it only summarizes the provisions of the Policy and is subject to the Policy's terms. This Certificate contains a Conversion Privilege. Accelerated Death Benefits paid under this Certificate or attached rider may be taxable. As with all tax matters, you should consult a professional tax advisor before applying for this benefit. Please read the Limitations section of the Accelerated Death Benefit included in this Certificate. Chief Executive Officer CERTIFICATE OF GROUP LIFE INSURANCE GL1102 FACE PAGE MA LIFE 01 08/01/05

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3 Berklee College of Music SCHEDULE OF INSURANCE CLASS 4 All Part-Time Staff who work a minimum of 910 hours per year WAITING PERIOD: MINIMUM HOURS: None (For date insurance begins, refer to "Effective Dates of Coverages" section) 910 hours per year LIFE AND AD&D INSURANCE Amount of Personal Life Insurance AD&D Insurance Principal Sum $25,000 $25,000 Personal Life and AD&D Insurance will be reduced as follows: - At age 70, benefits will reduce by 35% of the original amount. Benefits will terminate when you retire. If you first enroll for Personal Life and AD&D Insurance at age 70 or older, the above age reductions will apply to: - Any Guarantee Issue Amount available without evidence of insurability; and - The maximum amount of insurance for which you are eligible. GL1102-SB 08/01/05

4 SCHEDULE OF INSURANCE (CONTINUED) DEPENDENTS INSURANCE Dependent Amount of Life Insurance Spouse $5,000 Dependent Child (age 14 days to 6 months) 100 Dependent Child (age 6 months to 19 years, 25 years if a full-time student) 1,000 Spouse Life Insurance will terminate when your Spouse attains age 70. The following chart applies to the Extension of Death Benefit provision when benefits end upon attainment of the Social Security Normal Retirement Age: Year of Birth Normal Retirement Age 1937 and prior and 2 months and 4 months and 6 months and 8 months and 10 months and 2 months and 4 months and 6 months and 8 months and 10 months 1960 and later 67 Note: Persons born on January 1 of any year should refer to the Normal Retirement Age for the previous year. If any evidence of insurability is required, it will be provided at your own expense. GL1102-SB 08/01/05

5 TABLE OF CONTENTS Amount of Insurance...3 Definitions...3 Eligibility...4 Effective Dates of Coverages...4 Termination of Coverage...5 Death Benefit...6 Beneficiary...6 Assignments...7 Extension of Death Benefit...8 Accelerated Death Benefit...9 Conversion Privilege...11 Dependents Life Insurance...12 Accidental Death and Dismemberment Insurance...13 Safe Driver Benefit...15 Claims Procedures for Life or Accidental Death and Dismemberment Benefits...16 Prior Insurance Credit Provision...18 GL1102-TOC 2 08/01/05

6 AMOUNT OF INSURANCE The amount of your insurance is determined by the Schedule of Insurance in the Policy. The initial amount of coverage is the amount which applies to your class on the day your coverage takes effect. You may become eligible for increases in the amount of insurance in accord with the Schedule of Insurance. Any such increase will take effect on the latest of: (1) the first of the Insurance Month which coincides with or follows the date on which you become eligible for the increase; provided you are Actively at Work on that day; (2) the day you resume Active Work, if you are not Actively at Work on the day the increase would otherwise take effect; or (3) the day any required evidence of insurability is approved by the Company. Any decrease will take effect on the day of the change; whether or not you are Actively at Work. DEFINITIONS ACTIVE WORK or ACTIVELY AT WORK means an employee's full-time performance of all customary duties of his or her occupation at: (1) the EMPLOYER'S place of business; or (2) any other business location where the employee is required to travel. Unless disabled on the prior workday or on the day of absence, an employee will be considered Actively at Work on the following days: (1) a Saturday, Sunday or holiday which is not a scheduled workday; (2) a paid vacation day, or other scheduled or unscheduled non-workday; or (3) an excused or emergency leave of absence (except a medical leave). COMPANY means Jefferson Pilot Financial Insurance Company, a Nebraska corporation; whose Home Office address is 8801 Indian Hills Drive, Omaha, Nebraska DAY or DATE means at 12:01 A.M., Standard Time, at the Group Policyholder's place of business; when used with regard to eligibility dates and effective dates. It means 12:00 midnight, Standard Time, at the same place; when used with regard to termination dates. EMPLOYER means the Group Policyholder or the Participating Employer named on the Face Page. INSURANCE MONTH means: (1) that period of time beginning on the Issue Date of the Policy and extending for one month; and (2) each subsequent month beginning on the same day after that. PERSONAL INSURANCE means the insurance provided by the Policy on Insured Persons. PHYSICIAN means a licensed practitioner of the healing arts other than the Insured Person or a relative of the Insured Person. POLICY means the Group Insurance Policy issued by the Company to the Group Policyholder. A copy of the Policy may be examined upon request at the Home Office of the Group Policyholder. REGULAR PART-TIME EMPLOYEE means an employee of the EMPLOYER who is regularly scheduled to work at least the number of hours as shown in the Schedule of Insurance. GL (REV) 3 08/01/05

7 ELIGIBILITY If you are a Full-Time Employee and a member of an employee class shown in the Schedule of Insurance; then you will become eligible for the coverage provided by the Policy on the later of: (1) the Policy's date of issue; or (2) the day you complete the Waiting Period. WAITING PERIOD. (See Schedule of Insurance). EFFECTIVE DATES OF COVERAGES Your insurance is effective on the latest of: (1) the day you become eligible for the coverage; (2) the day you resume Active Work, if you are not Actively at Work on the day you become eligible; (3) the day you make written application for coverage; and sign: (a) a payroll deduction order, if you pay any part of the premium; or (b) an order to pay premiums from your Section 125 Plan account, if Employer contributions are paid through a Section 125 Plan; or (4) the day the Company approves your coverage, if evidence of insurability is required. Evidence of insurability is required if: (1) you apply for coverage more than 31 days after you become eligible; or (2) you make written application to re-enroll for coverage after you have requested: (a) to cancel your coverage; (b) to stop payroll deductions for the coverage; or (c) to stop premium payments from your Section 125 Plan account. EXCEPTION. If your coverage terminates due to an approved leave of absence or a military leave, any Waiting Period or evidence of insurability requirement will be waived upon your return; provided: (1) you return within six months after the leave begins; (2) you apply or are enrolled within 31 days after resuming Active Work; and (3) the reinstated amount of insurance does not exceed the amount which terminated. GL MA (FMLA) 4 08/01/05

8 TERMINATION OF COVERAGE Your coverage terminates on the earliest of: (1) the day the Policy terminates; (2) the last day of the Insurance Month in which you request termination; (3) the last day of the period for which the premium for your insurance has been paid; (4) the day you cease to be a member of an employee class shown in the Schedule of Insurance; (5) with respect to any particular insurance benefit, the day the part of the Policy providing that benefit terminates; (6) the day your employment with the Employer terminates; or (7) the day you enter the armed services of any state or country on active duty; except for duty of 30 days or less for training in the Reserves or National Guard. (If you send proof of military service, the Company will refund any unearned premium.) Ceasing Active Work terminates your eligibility, but coverage may be continued as follows: (1) If you do not become eligible for similar group coverage within 31 days after employment ends; then coverage may be continued until the earlier of: (a) the 31st day after employment ends; or (b) the day coverage would otherwise end; provided the required premium is paid on your behalf. (2) If you cease Active Work due to a plant closing (as defined by Massachusetts law); then coverage may be continued until the earlier of: (a) the 90th day after ceasing Active Work; or (b) the day coverage would otherwise end; provided the required premium is paid on your behalf. (3) If you cease Active Work due to an approved leave of absence to care for your dependent child under 3 years of age; then coverage (other than Weekly Disability Income Insurance) may be continued until the earlier of: (a) the day such approved leave of absence ends; or (b) the day coverage would otherwise end; provided the required premium is paid on your behalf. It may also be possible to continue all or part of your insurance during a temporary lay off, other approved leave of absence or military leave; or while you are unable to work due to sickness or injury. The conditions concerning such a continuance may be found in the Policy. See your Employer for this information. If you are entitled to continue coverage in accord with two or more provisions of the Policy, then you may elect the longest continuation period (but only one). GL MA (FMLA) 5 08/01/05

9 DEATH BENEFIT Upon receipt of satisfactory proof of your death, the Company will pay a death benefit equal to the amount of Personal Life Insurance in effect on the date of your death. The benefit will be paid in accord with the Beneficiary section. Arrangements may be made to have this death benefit paid in installments. BENEFICIARY Your Beneficiary is the person or persons named on your enrollment card. The Beneficiary may be changed in accord with the terms of the Policy. If you have not named a Beneficiary, or if no named Beneficiary is living when you die; then the death benefit will be paid to your: (1) surviving spouse; or, if none (2) surviving child or children in equal shares; or, if none (3) surviving parent or parents in equal shares; or, if none (4) surviving brothers and sisters in equal shares; or, if none (5) estate, or in accord with the Facility of Payment section of the Policy. GL A 96 Pref. Bene.-No Ext. 6 08/01/05

10 ASSIGNMENTS Personal Life Insurance and Accidental Death Insurance may be assigned. The assignments allowed under the Policy are absolute assignments and funeral assignments as described below. No assignment will be binding on the Company unless and until: (1) it is made on a form furnished by the Company; (2) the original is completed and filed with the Company at its Home Office; and (3) it is approved by the Company. The Company and the Employer do not assume responsibility for the validity or effect of an assignment. ABSOLUTE ASSIGNMENTS. You may make an irrevocable assignment of your Personal Life Insurance and Accidental Death Insurance as a gift (with no consideration), providing you have the legal capacity and the mental capacity to do so. It may be made to a trust or to one or more of your relatives, their estates, or to a trustee of a trust under which one of the relatives is a beneficiary. The term "relatives" includes, but is not limited to, your spouse, parents, grandparents, aunts, uncles, siblings, children, adopted children, stepchildren, and grandchildren. In some states, community property is an established form of ownership that must be considered in making an assignment. If you make an absolute assignment to two or more assignees, such assignees will be joint owners with the right of survivorship between them. You should consult with your own legal advisor before making an assignment. Once the assignment has been recorded by the Company, you can no longer change the beneficiary and cannot apply for conversion. Only the assignee can change the beneficiary designation if the previous designation is revocable. An assignment will have no effect on a prior irrevocable beneficiary designation. Only the assignee can apply for conversion but only when the Conversion Privilege provision would have been available to you in the absence of the assignment under the Policy. An absolute assignment cannot be used as a collateral assignment. FUNERAL ASSIGNMENTS. Upon your death, the beneficiary may assign the Personal Life Insurance benefit and Accidental Death Insurance benefit to a funeral home for payment of burial expenses. After payment has been made for the burial expenses to the assigned funeral home, the remaining death benefit is then paid in accord with the Beneficiary and Settlement Options sections of the Policy. GL C /01/05

11 EXTENSION OF DEATH BENEFIT IF YOU BECOME TOTALLY DISABLED Your life insurance will be continued, without payment of premiums, if: (1) you become Totally Disabled while insured and before reaching age 60; (2) you remain Totally Disabled for at least 6 months in a row; and (3) you submit satisfactory proof within the 7th through 12th months of disability; or: (a) as soon as reasonably possible after that; but (b) not later than the 24th month of disability, unless you were legally incapacitated. PREMIUM PAYMENT. Premium payments must continue until you are approved for this benefit, or the Policy terminates, if earlier. Upon receipt of satisfactory proof, the Company will refund up to 12 months' premium paid for your life insurance, from your 1st day of Total Disability. DEFINITION. For this benefit, Total Disability or Totally Disabled means you: (1) are unable, due to sickness or injury, to engage in any employment or occupation for which you are or become qualified by reason of education, training, or experience; and (2) are not engaging in any gainful employment or occupation. AMOUNT CONTINUED. The amount of Personal Life Insurance and any Dependent Life Insurance continued will be subject to the reductions and terminations in effect under the Policy on the day your Total Disability begins. Any Accidental Death and Dismemberment Benefit will not be continued. ADDITIONAL PROOF. From time to time, you must submit proof that your Total Disability is continuing. Proof will be at your expense; unless the Company requests to have you examined by a Physician of its choice. If you die after submitting proof, further proof must be submitted to the Company showing that you remained continuously and Totally Disabled until death. If you die within 12 months after Total Disability begins, but before submitting proof; then your death benefit will still be paid under the terms of the Policy. But the Company must first receive satisfactory proof of your continuous Total Disability, from your last day of Active Work until your date of death. TERMINATION. Any life insurance continued under this section will terminate automatically on: (1) the day you cease to be Totally Disabled; (2) the day you fail to take a required medical examination; (3) the 60th day after the Company mails a request for additional proof, if it is not given; (4) the effective date of your individual conversion policy, with respect to any amount of life insurance converted in accord with the Conversion Privilege section; or (5) the day you reach Social Security Normal Retirement Age (SSNRA), as shown in the Schedule of Insurance (whichever occurs first). If your Total Disability ends, and you do not return to a class eligible for Policy coverage; then you may exercise the Conversion Privilege. If your Total Disability ends, and you do return to an eligible class; then your Policy coverage will resume when premium payments are resumed, and any conversion policy is surrendered as provided in the Policy. GL Ext. to SSNRA 8 08/01/05

12 ACCELERATED DEATH BENEFIT BENEFIT. The Accelerated Death Benefit is an advance payment of part of your Personal Life Insurance. It may be paid to you, in a lump sum, once during your lifetime. To qualify, you must: (1) have satisfied the Active Work requirement under the Policy; (2) have been insured under the Policy: (a) on the date of an injury which results in a Terminal condition; or (b) for 30 days before being diagnosed Terminal as a result of sickness; and (3) have at least $2,000 of Personal Life Insurance under the Policy on the day before the Accelerated Death Benefit is paid. Receiving the Accelerated Death Benefit will reduce the Remaining Life Insurance and the Death Benefit payable at death, as shown on the next page. "Claimant," as used in this section, means the Terminal Insured Person for whom the Accelerated Death Benefit is requested. "Terminal" means you have a medical condition which is expected to result in death within 12 months, despite appropriate medical treatment. APPLYING FOR THE BENEFIT. To withdraw the Accelerated Death Benefit, you (or your legal representative) must send the Company: (1) written election of the Accelerated Death Benefit, on forms supplied by the Company; and (2) satisfactory proof that the Claimant is Terminal, including a Physician's written statement. The Company reserves the right to decide whether such proof is satisfactory. Before paying an Accelerated Death Benefit, the Company must also receive the written consent of any irrevocable beneficiary, assignee or bankruptcy court with an interest in the benefit. (See Limitations 3, 4, and 5.) NOTE: THIS IS NOT A LONG-TERM CARE POLICY. RECEIVING THIS ACCELERATED DEATH BENEFIT WILL REDUCE THE BENEFIT PAYABLE AT DEATH. ANY AMOUNT WITHDRAWN MAY BE TAXABLE INCOME, SO YOU SHOULD CONSULT A TAX ADVISOR BEFORE APPLYING FOR THIS BENEFIT. AMOUNT OF THE BENEFIT. You may elect to withdraw an Accelerated Death Benefit in any $1,000 increment; subject to: (1) a minimum of $1,000 or 10% of the Claimant's amount of Life Insurance (whichever is greater); and (2) a maximum of $250,000 or 75% of the Claimant's amount of Life Insurance (whichever is less). To determine the Accelerated Death Benefit, the Company will use the lesser of A or B below: A. the Claimant's amount of Life Insurance which is in force on the day before the Accelerated Death Benefit is paid; or B. the Claimant's amount of Life Insurance which would be in force 12 months after that date; if the coverage is scheduled to reduce, due to age, within 12 months after the Accelerated Death Benefit is paid. GL MA ADB-DEP. 9 08/01/05

13 ADMINISTRATIVE CHARGE: NONE WITHDRAWAL FEE: NONE EFFECT ON AMOUNT OF LIFE INSURANCE. "Remaining Life Insurance" means the amount of Life Insurance which remains in force on the Claimant's life after an Accelerated Death Benefit is paid. The Remaining Life Insurance will equal: (1) the Claimant's amount of Life Insurance which was used to determine the Accelerated Death Benefit (A or B above); minus (2) any percentage by which the Claimant's coverage is scheduled to reduce, due to age; if the reduction occurs more than 12 months after the Accelerated Death Benefit is paid, and while he or she is still living; minus (3) the amount of the Accelerated Death Benefit withdrawn. When an Accelerated Death Benefit is paid, the Insured Person will be issued a new Certificate Face Page or Schedule Page showing the amount of his or her Remaining Life Insurance. PREMIUM: There is no additional charge for this benefit. Continuation of the Remaining Life Insurance will be subject to timely payment of the premium for the reduced amount; unless you qualify for waiver of premium under the Policy's Extension of Death Benefit provision, if included. CONDITIONS. If the Claimant exercises the Conversion Privilege after an Accelerated Death Benefit is paid, the amount of the conversion policy will not exceed the amount of his or her Remaining Life Insurance. If the Claimant has Accidental Death and Dismemberment benefits under the Policy, the Principal Sum will not be affected by the payment of an Accelerated Death Benefit. EFFECT ON DEATH BENEFIT. When the Claimant dies after an Accelerated Death Benefit is paid, the amount of Remaining Life Insurance in force on the date of death will be paid as a Death Benefit. Your Death Benefit will be paid in accord with the Beneficiary section of the Policy. If the Claimant dies after application for an Accelerated Death Benefit has been made, but before the Company has made payment; then the request will be void and no Accelerated Death Benefit will be paid. The amount of Life Insurance in force on the date of death will be paid in accord with Policy provisions. EFFECT ON TAXES AND GOVERNMENT BENEFITS. Any Accelerated Death Benefit amount withdrawn may be taxable income to you. Receipt of the Accelerated Death Benefit may also affect the Claimant's eligibility for Medicaid, Supplemental Security Income and other government benefits. The Claimant should consult his or her own tax and legal advisor before applying for an Accelerated Death Benefit. The Company is not responsible for any tax owed or government benefit denied, as a result of the Accelerated Death Benefit payment. LIMITATIONS. No Accelerated Death Benefit will be paid: (1) if any required premium is due and unpaid; (2) on any conversion policy purchased in accord with the Conversion Privilege; (3) without the written approval of the bankruptcy court, if you have filed for bankruptcy; (4) without the written consent of the beneficiary, if you have named an irrevocable beneficiary; (5) without the written consent of the assignee, if you have assigned your rights under the Policy; (6) if any part of the Life Insurance must be paid to your child, spouse or former spouse; pursuant to a legal separation agreement, divorce decree, child support order or other court order; (7) if the Claimant is Terminal due to a suicide attempt, while sane or insane; or due to an intentionally self-inflicted injury; (8) if a government agency requires you or the Claimant to use the Accelerated Death Benefit to apply for, receive or continue a government benefit or entitlement; or (9) if an Accelerated Death Benefit has been previously paid for the Claimant under the Policy. GL MA ADB-DEP /01/05

14 CONVERSION PRIVILEGE GENERAL BENEFIT. If your insurance or insurance on a Dependent terminates for any reason except: (1) termination or amendment of the Policy; or (2) your request for: (a) termination of insurance; or (b) cancellation of your payroll deductions, an individual life policy (known as a conversion policy) may be purchased without evidence of insurability. To purchase a conversion policy, application and payment of the first premium must be made within 31 days after the life insurance is terminated. The conversion policy will: (1) be in an amount not to exceed the amount of life insurance which was terminated; (2) be on any form (except term) then issued by the Company at the age and amount for which application is made; (3) be issued at the person's age at nearest birthday; (4) be issued without disability or other supplemental benefits; and (5) require premiums based on the class of risk to which the person then belongs. CONVERSION BENEFIT WHEN POLICY IS TERMINATED OR AMENDED. A conversion policy also may be purchased if: (1) all or part of your insurance or insurance on a Dependent terminates due to amendment or termination of the Policy; and (2) the person applying for the conversion policy has been covered continuously under the Policy for at least 5 years. A conversion policy issued due to Policy termination or amendment will be subject to conditions (1) through (5) above; except its amount may not exceed the lesser of: (1) $2,000; or (2) the amount of life insurance which terminates; less the amount of any group life insurance for which the person becomes eligible within 31 days after the termination. The conversion policy will take effect on the later of: (1) its date of issue, or (2) 31 days after the date the insurance terminated. If death occurs during the 31 day conversion period; then the Company will pay the life insurance which could have been converted, even if no one applied for the conversion policy. When your insurance terminates, written notice of your right to convert will be given to you. If written notice is not given to you at least 15 days before the end of the 31 day conversion period, an additional period in which to convert will be granted. Any such extension of the conversion period will expire on the earlier of: (1) 15 days after you are given the written notice; or (2) 60 days after the 31 day conversion period ends, even if you are never given such notice. No death benefit will be payable under the Policy after the 31 day conversion period has expired even though the right to convert may be extended. GL MA 11 08/01/05

15 DEPENDENTS LIFE INSURANCE DEATH BENEFIT. If your Dependent dies while insured under the Policy, the Company will pay the amount of Dependents Life Insurance in effect on the date of the death. This amount is shown in the Schedule of Insurance. The death benefit will be paid to you. If you are not living when your Dependent dies, the death benefit will be paid to your beneficiary or in accord with the Facility of Payment section of the Policy. ELIGIBILITY. You become eligible for Dependents Life Insurance on the later of: (1) the date you become eligible for other coverages provided by the Policy; (2) the effective date of this section; or (3) the date you first acquire a Dependent (as defined by the Policy). EFFECTIVE DATE. Your Dependents Life Insurance will become effective on the later of: (1) the date you become eligible for Dependents Life Insurance; (2) the date you sign your payroll deduction order and apply for the coverage; or (3) the date the Company approves any required evidence of insurability on all your Dependents. If you acquire a new Dependent while insured for Dependents Life Insurance, his or her insurance will become effective on the date the Dependent is acquired. If a Dependent is confined in a hospital on the date insurance would otherwise take effect, his or her insurance will become effective on the 10th day following final discharge from the hospital. EVIDENCE OF INSURABILITY. Each of your Dependents must submit evidence of insurability to the Company, if you apply for Dependents Life Insurance: (1) more than 31 days after the date you become eligible for Dependents Life Insurance; or (2) after requesting to terminate Dependents Life Insurance or cancelling the payroll deduction order. INDIVIDUAL TERMINATION OF DEPENDENT INSURANCE. Your Dependents Life Insurance will cease for all your Dependents when: (1) your Personal Insurance terminates; (2) Dependent Life Insurance is discontinued under the Policy; (3) you cease to be in a class of employees eligible for Dependent Life Insurance; (4) you request that the Dependent Life Insurance be terminated; or (5) the last day of the period for which you have made any required contribution for the cost of the Dependents Life Insurance. Dependents Life Insurance on a particular Dependent will cease on: (1) the date such person ceases to be a Dependent (as defined by the Policy); or (2) the day the Dependent enters the armed forces of any state or country on active duty; except for duty of 30 days or less for training in the Reserves or National Guard. (If you send proof of military service, the Company will refund any unearned premium). GL /01/05

16 ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE DEATH OR DISMEMBERMENT BENEFIT FOR AN INSURED PERSON. The Company will pay the benefit listed below, if: (1) you sustain an accidental bodily injury while insured under this provision; and (2) that injury directly causes one of the following losses within 365 days after the date of the accident. The loss must result directly from the injury and from no other causes. LOSS BENEFIT FOR COMMON CARRIER ACCIDENT BENEFIT FOR OTHER COVERED ACCIDENT Loss of Life 2 Times Principal Sum Principal Sum Loss of One Member (Hand, Foot or Eye) Principal Sum 1/2 Principal Sum Loss of Two or More Members 2 Times Principal Sum Principal Sum The Principal Sum for your class is shown in the Schedule of Insurance. MAXIMUM PER PERSON. If you sustain more than one loss resulting from the same accident, the benefit: (1) will be the one largest amount listed; (2) will not exceed two times the Principal Sum for all of your combined losses resulting from a Common Carrier Accident; and (3) will not exceed the Principal Sum for all of your combined losses resulting from any other covered accident. TO WHOM PAYABLE. Benefits for your loss of life will be paid in accord with the Beneficiary section. All other benefits will be paid to you. LIMITATIONS. Benefits are not payable for any loss to which a contributing cause is: (1) intentional self-inflicted injury or self-destruction; (2) disease, bodily or mental infirmity, or medical or surgical treatment of these; (3) participation in a riot; (4) duty as a member of any military, naval or air force; (5) war or any act of war, declared or undeclared; (6) participation in the commission of a felony; (7) voluntary use of drugs; except when prescribed by a Physician; (8) voluntary inhalation of gas, including carbon monoxide; (9) travel or flight in any aircraft, including balloons and gliders; except as a fare paying passenger on a regularly scheduled flight; or (10) driving a vehicle while intoxicated. GL A 01 COMMON CARRIER 13 08/01/05

17 ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE CONTINUED DEFINITIONS. "Beneficiary" means the person(s) named on your enrollment form. You may change the Beneficiary by filing a written notice of the change with the Company at its Home Office. "Common Carrier Accident" means a covered accidental bodily injury, which is sustained while riding as a fare paying passenger (not a pilot, operator or crew member) in or on, boarding or getting off from a Common Carrier "Common Carrier" means any land, air or water conveyance operated under a license to transport passengers for hire. "Intoxicated" shall be defined by the jurisdiction where the accident occurs. The exclusion will apply whether or not the driver is convicted. "Loss of a Member" includes the following: (1) "Loss of Hand or Foot," means complete severance through or above the wrist or ankle joint. (In South Carolina, "Loss of Hand" can also mean the loss of four whole fingers from one hand.) (2) "Loss of an Eye," means total and irrevocable loss of sight in that eye. GL A 01 COMMON CARRIER 14 08/01/05

18 SAFE DRIVER BENEFIT BENEFIT. If you die as a direct result of a covered auto accident, for which Accidental Death and Dismemberment Benefits are payable; then: (1) an additional Seat Belt Benefit will be payable, if you were wearing a properly fastened seat belt at the time of the accident; and (2) an additional Air Bag Benefit will be payable, if the auto was equipped with air bag(s). The Seat Belt Benefit equals $10,000 or 10% of the Principal Sum, whichever is less; and the Air Bag Benefit equals $10,000 or 10% of the Principal Sum, whichever is less. The Seat Belt Benefit and the Air Bag Benefit will not be less than $1,000. The Principal Sum is the amount payable because of the Insured Person's accidental death. A copy of the police report must be submitted with the claim. The position of the seat belt or presence of an air bag must be certified by: (1) the official accident report; or (2) the coroner, traffic officer or other investigating officer. Upon receipt of satisfactory written proof, the additional benefit will be paid in accord with the Beneficiary section. DEFINITIONS. As used in this provision: "Auto" means a 4-wheel passenger car, station wagon, jeep, pick-up truck or van-type car. It must be licensed for use on public highways. It includes a car owned or leased by the Employer. "Intoxicated," "Impaired," or "Under the Influence of Drugs" shall be defined as by the jurisdiction where the accident occurs. "Seat Belt" means a properly installed: (1) seat belt or lap and shoulder restraint; or (2) other restraint approved by the National Highway Traffic Safety Administration. LIMITATIONS. Safe Driver Benefits will not be paid if: (1) the Accidental Death and Dismemberment Benefit is not paid under the Policy for your death; or (2) at the time of the accident, you or any other person who was driving the auto in which you were traveling: (a) was driving without a valid drivers' license; (b) was driving in excess of the legal speed limit; or (c) was driving while intoxicated, impaired, or under the influence of drugs (except for drugs taken as prescribed by a Physician for the driver's use). The above limitations will apply, whether or not the driver is convicted. GL A Seat Belt & Air Bag 15 08/01/05

19 CLAIMS PROCEDURES FOR LIFE OR ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS NOTE: If the Policy includes an Extension of Death Benefit or a Living Benefit (also called an Accelerated Death Benefit), please refer to that section for special claim procedures. NOTICE OF CLAIM. Written notice of claim must be given within 20 days after the loss occurs. The notice must be sent to the Company's Home Office. It should include: (1) your name and address; and (2) the number of the Policy. If this is not possible, written notice must be given as soon as it is reasonably possible. CLAIM FORMS. When notice of claim is received, the Company will send claim forms for filing the required proof. If the Company does not send the forms within 15 days; then you or your Beneficiary may send the Company written proof of claim in a letter stating the nature, date and cause of the loss. PROOF OF CLAIM. The Company must be given written proof of claim within 90 days after the date of the loss. If it was not reasonably possible to give written proof in the time required, the claim will not be reduced or denied solely for this reason; provided the proof is filed as soon as reasonably possible. In any event, proof of claim must be given no later than one year from such time. These time limits will not apply while you or your Beneficiary lacks legal capacity, however. Proof of claim must be provided at your or your Beneficiary's own expense. It must show the nature, date and cause of the loss. Documentation must include: (1) a certified copy of the death certificate, for proof of death; (2) a copy of any police report, for proof of accidental death or dismemberment; (3) a signed authorization for the Company to obtain more information; and (4) any other items the Company may reasonably require in support of the claim. EXAM OR AUTOPSY. At anytime while a claim is pending, the Company may: (1) have you examined by a Physician of the Company's choice, as often as reasonably required; and (2) deny or suspend benefits if you fail to attend an exam, without good cause; or fail to cooperate with the examiner. In case of death, the Company may also have an autopsy done, where it is not forbidden by law. Any such exam or autopsy will be at the Company's expense. TIME OF PAYMENT OF CLAIMS. Death or dismemberment benefits payable under the Policy will be paid as soon as the Company receives acceptable proof of claim. TO WHOM PAYABLE. Any benefits payable for your death will be paid in accord with the Beneficiary, Facility of Payment and Settlement Options sections of the Policy. If the Policy includes Dependent Life Insurance, any benefits payable for an insured Dependent's death will be paid to: (1) you, if you survive that Dependent; or (2) your Beneficiary, or in accord with the Facility of Payment section; if you do not survive that Dependent. If the Policy includes Accidental Death and Dismemberment Benefits; then any benefit, other than your death benefit, will be paid to you. NOTICE OF CLAIM DECISION. Within a reasonable time after receiving proof of claim, the Company will send you or your Beneficiary a written notice of their claim decision. If the Company denies any part of the claim, the written notice will: (1) explain the reason for the denial under the terms of the Policy; and (2) inform you or your Beneficiary of the right to a review of the Company's decision. If you or your Beneficiary do not receive a written decision within 90 days after the Company receives the claim; then there is a right to an immediate review, as if the claim was denied. GL1102-8A L/ADD 16 08/01/05

20 CLAIMS PROCEDURES - CONTINUED REVIEW PROCEDURE. Within 60 days after receiving a denial notice, you or your Beneficiary may request a claim review by sending the Company a written request, along with any written comments or other items to support the claim. You or your Beneficiary may review certain non-privileged information relating to the request for review. The Company will review the claim and send you or your Beneficiary a written notice of their decision within 60 days after receiving the request for review; or within 120 days, if special circumstances require an extension. The notice will state the reasons for the Company's decision under the terms of the Policy. RIGHT OF RECOVERY. If benefits have been overpaid on any claim, full reimbursement to the Company is required within 60 days. If reimbursement is not made, the Company has the right to: (1) reduce future benefits until full reimbursement is made; and (2) recover such overpayments from you, your Beneficiary or estate. Such reimbursement is required whether the overpayment is due to fraud, the Company's error in processing a claim, or any other reason. LEGAL ACTIONS. No legal action to recover any benefits may be brought until 60 days after the required written proof of claim has been given. No legal action may be brought more than three years after written proof of claim is required to be given. COMPANY'S DISCRETIONARY AUTHORITY. Except for those functions which the Policy specifically reserves to the Group Policyholder or Employer, the Company has the authority to manage the Policy, to administer claims, to interpret Policy provisions, and to resolve questions arising under the Policy. The Company's authority includes (but is not limited to) the right to: (1) establish and enforce procedures for administering the Policy and claims under it; (2) determine Employees' eligibility for insurance and entitlement to benefits; (3) determine what information the Company reasonably requires to make such decisions; and (4) resolve all matters when a claim review is requested. Any decision the Company makes, in the exercise of its authority, shall be conclusive and binding; subject to your or your Beneficiary's right to request a state insurance department review or to bring legal action. GL1102-8A L/ADD 17 08/01/05

21 CERTIFICATE AMENDMENT TO BE ATTACHED TO THE CERTIFICATE FOR GROUP POLICY NO.: ISSUED TO: Berklee College of Music Your Certificate is amended by the addition of the following provisions. PRIOR INSURANCE CREDIT UPON TRANSFER OF LIFE INSURANCE CARRIERS This provision prevents loss of life insurance coverage for you, which could otherwise occur solely because of a transfer of insurance carriers. The Policy will provide the following Prior Insurance Credit, when it replaces a prior plan. "Prior Plan" means a prior carrier's group life insurance policy, which the Policy replaced within 1 day of the prior plan's termination date. FAILURE TO SATISFY ACTIVE WORK RULE. Subject to payment of premiums, the Policy will provide life coverage if you: (1) were insured under the prior plan on its termination date; (2) were otherwise eligible under the Policy; but were not Actively-At-Work due to Injury or Sickness on its Effective Date; (3) are not entitled to any extension of life insurance under the prior plan; and (4) are not Totally Disabled (as defined in the Extension of Death Benefit section of the Policy) on the date the Policy takes effect. AMOUNT OF LIFE INSURANCE. Until you satisfy the Policy's Active Work rule, the amount of your group life insurance under the Policy will not exceed the amount for which you were insured under the prior plan on its termination date. This Amendment takes effect on your effective date of coverage under the Policy. In all other respects, your Certificate remains the same. Jefferson Pilot Financial Insurance Company 8801 Indian Hills Drive, Omaha, NE Officer of the Company GL1102-AMEND. PC1 MA Prior Ins. Cred. - Life 18 08/01/05

22 SUMMARY PLAN DESCRIPTION The following information together with your group insurance certificate issued to you by Jefferson Pilot Financial Insurance Company of Omaha, Nebraska, is the Summary Plan Description required by the Employee Retirement Income Security Act of 1974 to be distributed to participants in the Plan. This Summary Plan Description is only intended to provide an outline of the Plan's benefits. The Plan Document will govern if there is any discrepancy between the information contained in this Description and the Plan. The name of the Plan is: Group Life, Dependent Life and Accidental Death and Dismemberment Insurance for Employees of Berklee College of Music. The name, address and ZIP code of the Sponsor of the Plan is: Berklee College of Music, 1140 Boylston Street, Boston, MA, Employer Identification Number (EIN): IRS Plan Number: 504 The name, business address, ZIP code and business telephone number of the Plan Administrator is: Berklee College of Music, 1140 Boylston Street, Boston, MA, 02215, (617) The Plan Administrator is responsible for the administration of the Plan and is the designated agent for the service of legal process for the Plan. Functions performed by the Plan Administrator include: the receipt and deposit of contributions, maintenance of records of Plan participants, authorization and payment of Plan administrative expenses, selection of the insurance consultant, selection of the insurance carrier and assisting Jefferson Pilot Financial Insurance Company. Jefferson Pilot Financial Insurance Company has the sole discretionary authority to determine eligibility and to administer claims in accord with its interpretation of policy provisions, on the Plan Administrator's behalf. Type of Administration. The Plan is administered directly by the Plan Administrator with benefits provided in accordance with provisions of the group insurance policy issued by Jefferson Pilot Financial Insurance Company whose Home Office address is 8801 Indian Hills Drive, Omaha, Nebraska. Type of Plan. The benefits provided under the Plan are: Group Life, Dependent Life and Accidental Death and Dismemberment Insurance benefits. Type of Funding Arrangement: Jefferson Pilot Financial Insurance Company. All employees are given a Certificate of Group Insurance which contains a detailed description of the Benefits. The Certificate also contains the Schedule of Insurance which includes the amount of Personal Life insurance, AD&D Principal Sum, Dependent Life amounts (if any), Waiting Period and age reduction information. If your Booklet, Certificate or Schedule of Insurance has been misplaced, you may obtain a copy from the Plan Administrator at no charge. Eligibility. Regular part-time employees working at least 910 hours per year. Employees become eligible on the first day of active regular part-time employment. Contributions. You are not required to make contributions for Personal Life Insurance and AD&D Insurance. You are required to make contributions for Dependent Life Insurance. The Plan's year ends on: December 31st of each year. The name and section of relevant Collective Bargaining Agreements: None The name, title and address of each Plan Trustee: None GL-SPD (LI/AD&D/Dep LI) 08/01/05

23 Loss of Benefits. The Plan Administrator may terminate the policy, or subject to Jefferson Pilot Financial Insurance Company's approval, may modify, amend or change the provisions, terms and conditions of the policy. Coverage will also terminate if the premiums are not paid when due. No consent of any Insured Person or any other person referred to in the policy will be required to terminate, modify, amend or change the policy. See your Plan Administrator to determine what, if any, arrangements may be made to continue your coverage beyond the date you cease active work. Claims Procedures. You may obtain claim forms and instructions for filing claims from the Plan Administrator or from the Home Office of Jefferson Pilot Financial Insurance Company. To expedite the processing of your claim, instructions on the claim form should be followed carefully; be sure all questions are answered fully. In accordance with ERISA, Jefferson Pilot Financial Insurance Company will send you or your beneficiary a written notice of its claim decision within: 90 days after receiving the first proof of a death or dismemberment claim (180 days under special circumstances); 45 days after receiving the first proof of a claim for any Extension of Death Benefit or Accelerated Death Benefit, if available under the Policy (105 days under special circumstances). If a claim is partially or wholly denied, this written notice will explain the reason(s) for denial, how a review of the decision may be requested, and whether more information is needed to support the claim. You, or another person on your behalf, may request a review of the claim by making a written request Jefferson Pilot Financial Insurance Company within: 60 days after receiving a denial notice of a death or dismemberment claim; 180 days after receiving a denial notice of a claim for any Extension of Death Benefit or Accelerated Death Benefit, if available under the Policy. This written request for review should state the reasons why you feel the claim should not have been denied and should include any additional documentation to support your claim. You may also submit for consideration additional questions or comments you feel are appropriate, and you may review certain non-privileged information relating to the request for review. Jefferson Pilot Financial Insurance Company will make a full and fair review of the claim and provide a final written decision to you or your beneficiary within: 60 days after receiving the request for a review of a death or dismemberment claim (120 days under special circumstances); 45 days after receiving the request for review of a claim for any Extension of Death Benefit or Accelerated Death Benefit, if available under the Policy (90 days under special circumstances). If more information is needed to resolve a claim, the information must be supplied within 45 days after requested. Any resulting delay will not count toward the above time limits for claims or appeals processing. Please refer to your certificate of insurance for more information about how to file a claim, how to appeal a denied claim, and for details regarding the claims procedures. Statement of ERISA Rights The following statement of ERISA rights is required by federal law and regulation. As a participant in this plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to: Receive Information About Your Plan and Benefits. Examine, without charge, at the Plan Administrator's office and at other specified locations, such as work sites and union halls, all documents governing the plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series), if any, filed by the plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Pension and Welfare Benefit Administration. Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series), if any, and updated summary plan description. The administrator may make a reasonable charge for copies. Receive a summary of the plan's annual financial report if the plan covers 100 or more participants. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report. Prudent Actions by Plan Fiduciaries. In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your plan, called "fiduciaries" of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA. Enforce Your Rights. If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. If it should happen that plan fiduciaries misuse the plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous. Assistance with Your Questions. If you have any questions about your plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the plan administrator, you should contact the nearest office of the Pension and Welfare Benefits Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Pension and Welfare Benefits Administration. GL-SPD (LI/AD&D/Dep LI) 08/01/05